<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Day_signin_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-day_signin_num" class="form-control" name="row[day_signin_num]" type="number" value="200">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Three_signin_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-three_signin_num" class="form-control" name="row[three_signin_num]" type="number" value="400">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Seven_signin_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-seven_signin_num" class="form-control" name="row[seven_signin_num]" type="number" value="1000">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Share_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-share_num" class="form-control" name="row[share_num]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Barrage_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-barrage_num" class="form-control" name="row[barrage_num]" type="number" value="200">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Look_num')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-look_num" class="form-control" name="row[look_num]" type="number" value="300">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Qrcode_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-qrcode_image" class="form-control" size="50" name="row[qrcode_image]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-qrcode_image" class="btn btn-danger faupload" data-input-id="c-qrcode_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-qrcode_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-qrcode_image" class="btn btn-primary fachoose" data-input-id="c-qrcode_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-qrcode_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-qrcode_image"></ul>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
